0:00:02 > 0:00:05The NHS.
0:00:05 > 0:00:08A national institution since 1948.
0:00:10 > 0:00:14Promising free health care to the residents of Britain.
0:00:17 > 0:00:22But now, we reveal how NHS managers can cash in on that promise.
0:00:22 > 0:00:24So how much is that in total?
0:00:25 > 0:00:27800? That's a bit much.
0:00:27 > 0:00:31Every year, the NHS is being used by thousands
0:00:31 > 0:00:34of so-called health tourists -
0:00:34 > 0:00:37foreign nationals who are not entitled to its care
0:00:37 > 0:00:39and who don't pay for the privilege.
0:00:41 > 0:00:45Using journalists from all over the world, we go undercover
0:00:45 > 0:00:49in a black market where access to GPs is being bought and sold.
0:00:53 > 0:00:56We find out how easy it is for health tourists
0:00:56 > 0:01:01to get X-rays, MRI scans and blood tests in hospital for free.
0:01:01 > 0:01:04Did anybody ever ask you if you were ordinarily resident in the country?
0:01:04 > 0:01:06Nobody did.
0:01:06 > 0:01:09Critics say the whole system is flawed.
0:01:09 > 0:01:11This is the poor old NHS being given the task
0:01:11 > 0:01:13of implementing something which is unworkable.
0:01:13 > 0:01:16We discover how the NHS is losing millions of pounds
0:01:16 > 0:01:19to other European countries.
0:01:19 > 0:01:23And how our NHS passport into Europe is wide open to fraud.
0:01:29 > 0:01:34'Tonight on Panorama, as the NHS struggles to make savings, we show
0:01:34 > 0:01:37'how secret health tourists cost us millions.'
0:01:37 > 0:01:41- You've been abusing your position. - I haven't done anything. Sorry.
0:01:48 > 0:01:52Britain is one of the most multicultural societies on earth.
0:01:53 > 0:01:56Every year, thousands of tourists and migrants come here
0:01:56 > 0:02:00for pleasure, to do business or to make a better life for themselves.
0:02:03 > 0:02:08So how much of our public services SHOULD they be allowed to use?
0:02:09 > 0:02:12The short answer is, it's not clear.
0:02:12 > 0:02:15Despite recent NHS guidance, we've discovered continuing uncertainty
0:02:15 > 0:02:19about who has the right to register with a GP.
0:02:20 > 0:02:22Hospitals are a different story.
0:02:22 > 0:02:25Most foreigners should pay for hospital services,
0:02:25 > 0:02:28either in person or through their governments.
0:02:28 > 0:02:30Now, all of this has led to confusion
0:02:30 > 0:02:33and left the system open to abuse.
0:02:38 > 0:02:40SIRENS
0:02:40 > 0:02:44We began our investigation in the spring, by finding out
0:02:44 > 0:02:47whether we could buy our way into the GP system.
0:02:50 > 0:02:52Through contacts in Lagos, we've been given
0:02:52 > 0:02:56the details of a Nigerian in London called Femi,
0:02:56 > 0:02:58who says he gets health tourists
0:02:58 > 0:03:01registered with a doctor for a price.
0:03:03 > 0:03:05'I'm going to meet a Nigerian journalist
0:03:05 > 0:03:08'who now lives here, Francis.
0:03:08 > 0:03:10'He'll be pretending he's come to Britain
0:03:10 > 0:03:12'to get treatment he's not entitled to.'
0:03:12 > 0:03:15Hi. I'm Declan. Nice to meet you, how are you doing?
0:03:16 > 0:03:21He says he can get someone registered with a GP for a price.
0:03:21 > 0:03:24Film what happens next, go along with it,
0:03:24 > 0:03:28- and see if he can get you registered as he says he can.- All right.
0:03:31 > 0:03:34It's early June. Our man Francis
0:03:34 > 0:03:38has arranged to meet the fixer in Woolwich, south-east London.
0:03:43 > 0:03:47If the fixer, Femi, can get us registered with the GP,
0:03:47 > 0:03:51it will be the first step to getting free treatment on the NHS.
0:03:55 > 0:03:57Francis heads to the bookies' and waits.
0:03:57 > 0:04:00And then the fixer, Femi, arrives.
0:04:16 > 0:04:19We have given Francis a medical complaint -
0:04:19 > 0:04:23a problem with his legs known as restless leg syndrome,
0:04:23 > 0:04:26a nervous condition which causes discomfort, particularly at night.
0:04:26 > 0:04:28It's enough to make Femi curious.
0:04:39 > 0:04:42So can this fixer get us registered, no questions asked,
0:04:42 > 0:04:43at a doctor's surgery?
0:05:01 > 0:05:03'Femi is offering an open door'
0:05:03 > 0:05:05'into the NHS. But it doesn't come cheap.
0:05:05 > 0:05:08'He says we'll have to pay £300 for the privilege.'
0:05:22 > 0:05:26'It looks like Francis is about to enter the system.
0:05:26 > 0:05:29'The common term for what he's doing is health tourism.
0:05:31 > 0:05:34'The NHS is a magnet for people of all backgrounds,
0:05:34 > 0:05:36'some wealthy, some not.
0:05:38 > 0:05:41'But it has its own police force to fight fraud.
0:05:41 > 0:05:44'I went to meet its former head.'
0:05:44 > 0:05:46I can think of examples of people who came from China
0:05:46 > 0:05:50to actually obtain free treatment.
0:05:50 > 0:05:53There are examples from Africa too.
0:05:53 > 0:05:58But it would be wrong to imagine that there is one source of people
0:05:58 > 0:06:01who come to this country to actually seek free health treatment,
0:06:01 > 0:06:03wherever their own countries
0:06:03 > 0:06:06don't provide the quality of health care that they would want,
0:06:06 > 0:06:09or they're seeking to get something on the cheap.
0:06:10 > 0:06:13'Gail Beer is the former head of a large London hospital.
0:06:13 > 0:06:16'She believes when it comes to health tourism,
0:06:16 > 0:06:18'the biggest problem isn't people flying in for treatment,
0:06:18 > 0:06:22'but people already here who need to access the system.'
0:06:22 > 0:06:24We define it as health tourism,
0:06:24 > 0:06:27but in fact that's a small number of people who come over here
0:06:27 > 0:06:29deliberately to have a particular treatment.
0:06:29 > 0:06:31There is a much larger number
0:06:31 > 0:06:32who are not eligible for treatment,
0:06:32 > 0:06:35because they're not ordinarily resident.
0:06:35 > 0:06:37It may be an illegal immigrant.
0:06:37 > 0:06:39But on the other hand, it's ex-pats who've lived abroad
0:06:39 > 0:06:43and then come back into this country. So there's quite a wide range.
0:06:47 > 0:06:51For illegal immigrants living in a shadow economy,
0:06:51 > 0:06:54becoming ill can be a costly and dangerous business.
0:06:54 > 0:06:58It can lead to them being exploited by unscrupulous middlemen.
0:06:58 > 0:07:02I wanted to meet one for myself, so I'm going undercover,
0:07:02 > 0:07:06and I'll be helped by our second undercover operative, Raj.
0:07:10 > 0:07:13'We had heard that in immigrant communities all over the country,
0:07:13 > 0:07:16'these middlemen were taking cash to get people access to doctors.'
0:07:18 > 0:07:20..A man by the name of Ayub...
0:07:20 > 0:07:23'He's made contact with a middleman in the Indian community
0:07:23 > 0:07:26'who claims he can register you with a doctor at a practice
0:07:26 > 0:07:30'that normally requires ID. To see if that's true,
0:07:30 > 0:07:33'I'm pretending to be an illegal immigrant from Kosovo
0:07:33 > 0:07:35'who has severe back pain.'
0:07:35 > 0:07:39And you're going to go by the name of Dardan Luma.
0:07:39 > 0:07:41Dardan Luma.
0:07:41 > 0:07:45'It's risky, but it will allow me to meet the middleman up close.'
0:07:47 > 0:07:49So we're on our way to meet Ayub.
0:07:49 > 0:07:53He's given us a time and a place to meet him.
0:07:53 > 0:07:55Now, he says he can get me a legitimate NHS card
0:07:55 > 0:07:58and also get me on a doctor's list.
0:07:58 > 0:08:00And that will be the first step
0:08:00 > 0:08:02towards me getting treated for free on the NHS.
0:08:04 > 0:08:05Ayub? Dardan.
0:08:24 > 0:08:27'I tell him I've got a bad back and I need a doctor.'
0:08:54 > 0:08:57'What will I actually get for my money?'
0:09:04 > 0:09:06'I ask how many times I can see the doctor.'
0:09:13 > 0:09:17'Ayub has bought my Dardan Luma character, the Kosovan alias.
0:09:17 > 0:09:22'Dardan is going to get his own NHS number on the doctor's card
0:09:22 > 0:09:25'and a place on a doctor's list.
0:09:25 > 0:09:29'Remember, everything about Dardan is fake - his name, his address,
0:09:29 > 0:09:31'his date of birth.
0:09:31 > 0:09:34'Now it's a waiting game to see if Ayub delivers.'
0:09:44 > 0:09:47Back in south London, and we've heard from Femi again.
0:09:47 > 0:09:50He's the Nigerian fixer, promising our undercover man
0:09:50 > 0:09:54posing as a health tourist free treatment on the NHS.
0:09:54 > 0:09:58And he's offering a personal service.
0:09:58 > 0:10:00He takes our secret health tourist, Francis,
0:10:00 > 0:10:02to be registered at a GP's surgery.
0:10:04 > 0:10:07Together, they fill in the registration form.
0:10:33 > 0:10:37It looks like the fixer has delivered on his promise.
0:10:37 > 0:10:38Francis is registered.
0:10:49 > 0:10:52So is the fixer, Femi, telling the truth?
0:10:52 > 0:10:53Does he have someone on the inside?
0:10:53 > 0:10:57Or is this service available to anyone who walks into the surgery
0:10:57 > 0:10:59with a friend from overseas?
0:11:01 > 0:11:04To find out, we call the surgery to check.
0:11:04 > 0:11:08To see how they'd handle a request from any other overseas visitor.
0:11:08 > 0:11:12They told us they wouldn't register a health tourist.
0:11:12 > 0:11:16So Femi is getting a service not available to the rest of us.
0:11:16 > 0:11:20It looks like he's got an arrangement to register
0:11:20 > 0:11:23whoever he wants, no questions asked.
0:11:23 > 0:11:27And by taking cash for this service, he may be committing fraud.
0:11:37 > 0:11:39So should the NHS be opened up
0:11:39 > 0:11:42to anyone who has made it to this country?
0:11:42 > 0:11:44Or should it draw a line in the sand
0:11:44 > 0:11:46and deliver only emergency treatment
0:11:46 > 0:11:48to people who are not entitled to care,
0:11:48 > 0:11:51as happens in some other countries?
0:11:53 > 0:11:54Nice to meet you...
0:11:54 > 0:11:56'That has become a hot political issue.
0:11:56 > 0:12:02'The pressure group, Migration Watch, campaigns on immigration.'
0:12:02 > 0:12:04It's a National Health Service.
0:12:04 > 0:12:06It's not an international health service.
0:12:06 > 0:12:08Our founding fathers... Nye Bevan, I'm sure,
0:12:08 > 0:12:10didn't think he was going to provide
0:12:10 > 0:12:13a service that provided health care for the whole world.
0:12:13 > 0:12:15That wasn't what it was all about.
0:12:15 > 0:12:16And it shouldn't be.
0:12:17 > 0:12:19But others believe that
0:12:19 > 0:12:21the regulations governing the health service
0:12:21 > 0:12:24should allow it to treat EVERYONE in the UK.
0:12:24 > 0:12:28Visitors, residents, and illegal immigrants alike.
0:12:28 > 0:12:31It is going to cause damage to individuals' health.
0:12:31 > 0:12:33The other side of it is public health as well.
0:12:33 > 0:12:36If you're dealing with contagious diseases of one sort or other,
0:12:36 > 0:12:40then there could be other victims as a result of poor regulation.
0:12:42 > 0:12:45Under the current system,
0:12:45 > 0:12:48some vulnerable illegal immigrants are paying middlemen
0:12:48 > 0:12:50so that they get treatment on the NHS
0:12:50 > 0:12:53without questions about their immigration status.
0:12:55 > 0:12:59But for a few, accessing the NHS below the radar
0:12:59 > 0:13:02can come at a huge personal cost.
0:13:02 > 0:13:04Meet Daljit.
0:13:04 > 0:13:07He's an illegal immigrant who got
0:13:07 > 0:13:10£15,000 worth of free treatment on the NHS.
0:13:10 > 0:13:14In 1996, Daljit was smuggled into the UK from India
0:13:14 > 0:13:17and worked illegally on building sites.
0:13:17 > 0:13:21He began to feel debilitating pain in his hips.
0:13:21 > 0:13:23It turned out that long hours operating a pneumatic drill
0:13:23 > 0:13:26had destroyed his hip joints.
0:13:26 > 0:13:28He needed help.
0:13:44 > 0:13:46So this is a middleman?
0:13:48 > 0:13:50'Daljit says he had no choice
0:13:50 > 0:13:53'because, officially, he didn't exist.'
0:14:05 > 0:14:09Did the GP know that you were an illegal immigrant?
0:14:16 > 0:14:18He says the hospital did ask him
0:14:18 > 0:14:21if he was living here legally.
0:14:21 > 0:14:23He simply lied. And nobody checked.
0:14:28 > 0:14:30So you got treated, then, on the NHS?
0:14:30 > 0:14:32Yeah.
0:14:32 > 0:14:33What did they do for you?
0:14:45 > 0:14:47What was wrong with your right leg?
0:14:47 > 0:14:50Right, so you've had a double hip replacement?
0:14:50 > 0:14:52On the NHS?
0:14:55 > 0:14:57Following his hip replacement,
0:14:57 > 0:15:00Daljit should have seen his GP regularly.
0:15:00 > 0:15:03But, remember, he was operating through a middleman.
0:15:03 > 0:15:06Every GP visit would have cost him money.
0:15:06 > 0:15:09That's why, four years after his operation,
0:15:09 > 0:15:12he's in bad shape.
0:15:12 > 0:15:13So this is where you live?
0:15:22 > 0:15:25This place is horrible.
0:15:25 > 0:15:28And...you must be freezing here at night? Are you?
0:15:36 > 0:15:39Now he's desperate to go home to India.
0:15:39 > 0:15:42He claims he asked the Home Office to deport him,
0:15:42 > 0:15:44but he says they refused.
0:15:55 > 0:15:57Back in Southall, our undercover reporter
0:15:57 > 0:15:59has met up with the middleman
0:15:59 > 0:16:01to check whether my alias,
0:16:01 > 0:16:03the Kosovan builder, Dardan Luma,
0:16:03 > 0:16:05has got his doctor's appointment.
0:16:08 > 0:16:10To make sure it's done, the middleman is introducing us
0:16:10 > 0:16:13to his accomplice, one step up the chain -
0:16:13 > 0:16:14Chamanlal.
0:16:39 > 0:16:43Chamanlal has promised our man will be an NHS patient soon.
0:16:50 > 0:16:53So far, we've uncovered a world of middlemen
0:16:53 > 0:16:55and fixers who have paved the way
0:16:55 > 0:16:57into GP surgeries from the outside.
0:16:59 > 0:17:02Then, we heard about an NHS insider
0:17:02 > 0:17:04working within the system.
0:17:06 > 0:17:09He's a practice manager here in Birmingham,
0:17:09 > 0:17:12said to be arranging access for health tourists to doctors.
0:17:14 > 0:17:17'Our undercover man, Raj, has already been to see him.'
0:17:17 > 0:17:20- You've made a contact?- Yes.
0:17:20 > 0:17:24I've made a contact with a man called Asif Butt.
0:17:24 > 0:17:26'And it appears he's willing to do business.'
0:17:26 > 0:17:29I let it be known to him my cover,
0:17:29 > 0:17:34which is that I'm a travel agent, tour operator, based here,
0:17:34 > 0:17:37who is taking care of wealthy clients from India.
0:17:39 > 0:17:42But our undercover man isn't working alone.
0:17:45 > 0:17:47Meet our next undercover operative.
0:17:47 > 0:17:49She's an English journalist,
0:17:49 > 0:17:52but that's not what she'll be telling the NHS practice manager.
0:17:52 > 0:17:54And your name is going to be Preeti Tagar.
0:17:54 > 0:17:56Preeti Tagar. OK. Got it.
0:17:56 > 0:18:00Raj's cover story is that Preeti is his niece.
0:18:00 > 0:18:03He'll say she's just arrived from India
0:18:03 > 0:18:05and is not entitled to NHS care.
0:18:05 > 0:18:06A health tourist.
0:18:12 > 0:18:14Asif Butt greets us outside
0:18:14 > 0:18:16the large Sparkbrook Health Centre in Birmingham
0:18:16 > 0:18:19where he's one of the practice managers.
0:18:26 > 0:18:30He ushers our man, Raj, into a doctors' private room.
0:18:30 > 0:18:33Asif had already offered to register Preeti at the centre
0:18:33 > 0:18:35without the ID they normally request.
0:18:35 > 0:18:38We wanted to know how he was progressing.
0:18:50 > 0:18:53Our undercover reporter has already discussed that he may have
0:18:53 > 0:18:56tourists from his travel agency who are interested.
0:18:56 > 0:18:57Asif is keen.
0:19:12 > 0:19:16Asif then hands us the registration forms for our potential
0:19:16 > 0:19:20health tourists - 14 of them. It looks like open house on the NHS.
0:19:24 > 0:19:2812, 13, 14.
0:19:38 > 0:19:41It seems it couldn't be simpler.
0:19:41 > 0:19:43Our fictitious health tourists don't even need to show up.
0:19:43 > 0:19:47All we have to do is fill in the forms, and they are in.
0:20:07 > 0:20:11Asif tells us that he's not processed a big group of health tourists like this before,
0:20:11 > 0:20:14but he has done them one at a time.
0:20:39 > 0:20:43Having sworn us to secrecy, Asif says he'll be in touch soon.
0:20:44 > 0:20:49Until recently, there was huge confusion in the system
0:20:49 > 0:20:54as to whether health tourists and illegal immigrants had the right to register on an NHS list.
0:20:54 > 0:20:57Some GPs did, many didn't.
0:20:57 > 0:21:03But in July of this year, an NHS body issued a clarification of the guidance.
0:21:03 > 0:21:05Doctors are now told overseas visitors,
0:21:05 > 0:21:11whether lawfully in the UK or not, ARE eligible to register with a GP.
0:21:11 > 0:21:15The guidance adds that GPs should NOT turn down patients
0:21:15 > 0:21:19because they fail to provide proof of ID or address.
0:21:19 > 0:21:23In effect, GPs are advised they should now take all comers.
0:21:25 > 0:21:28It follows a number of successful legal challenges to GPs
0:21:28 > 0:21:32who have refused primary care to illegal immigrants.
0:21:33 > 0:21:37Adam Hunt is one of the lawyers leading these challenges.
0:21:37 > 0:21:40A particularly memorable case that I dealt with was
0:21:40 > 0:21:43a young and vulnerable teenage mother.
0:21:43 > 0:21:48She had a young baby, she'd been a victim of sex trafficking,
0:21:48 > 0:21:51and the baby was a result of enforced prostitution.
0:21:51 > 0:21:56And before she came to me for help, she'd spent nine, 12 months
0:21:56 > 0:22:00looking for a GP and being turned away and turned away and turned away.
0:22:00 > 0:22:04How many cases have you taken against GPs who've refused to register people?
0:22:04 > 0:22:11Er, I suppose probably about 30 or 40 over the last two or three years.
0:22:11 > 0:22:16- And have you ever lost? - No. No, no-one's fought any of them.
0:22:16 > 0:22:19I suspect because as soon as they take legal advice,
0:22:19 > 0:22:22they know that they... That we are right.
0:22:24 > 0:22:25But not everyone agrees.
0:22:27 > 0:22:32Dr Chris Clayton-Payne has a practice in rural Saffron Walden.
0:22:32 > 0:22:33He says his surgery still sees
0:22:33 > 0:22:36eight to ten overseas visitors a week.
0:22:36 > 0:22:40The guidance changed radically in July of this year
0:22:40 > 0:22:46when we received an e-mail from the NHS Primary Care Commissioning organisation.
0:22:46 > 0:22:50And quite clearly states who is and who is not entitled
0:22:50 > 0:22:56to National Health Service care in the UK as an overseas visitor.
0:22:56 > 0:23:01- That is, basically, everybody is now entitled to...- Everybody?- Everybody.
0:23:01 > 0:23:04We are not allowed to make any discrimination.
0:23:04 > 0:23:07What's your reaction to that?
0:23:07 > 0:23:10It seems very strange, when we are shaving off the pennies here and there,
0:23:10 > 0:23:14to actually open the door wide open to the citizens of the world
0:23:14 > 0:23:19to walk in and have free medical care at primary care level in the UK.
0:23:20 > 0:23:25I went to ask the health minister at her constituency office about the change in guidance.
0:23:26 > 0:23:31If doctors are now obliged to register everyone, though,
0:23:31 > 0:23:35isn't it the case that the system is therefore open to abuse?
0:23:35 > 0:23:39We know there are abuses, but we know that some GP practices
0:23:39 > 0:23:43put quite strict rules and regulations in place
0:23:43 > 0:23:45before they will accept somebody on their books,
0:23:45 > 0:23:48and we've got to tighten up the system. That's why we're having the review.
0:23:48 > 0:23:53But the government review into how the NHS deals with overseas visitors
0:23:53 > 0:23:54won't be out until next year.
0:23:54 > 0:24:00For the time being, many GPs seem unaware of the new guidance.
0:24:01 > 0:24:06Each of the surgeries where our undercover operatives are buying black-market access
0:24:06 > 0:24:12officially still has a policy of not registering health tourists or demanding ID.
0:24:14 > 0:24:17Meanwhile, the black market prospers.
0:24:19 > 0:24:22In West London, Chamanlal meets us again to let us know
0:24:22 > 0:24:25how the registration of the Kosovan immigrant, Dardan Luma, is going.
0:24:44 > 0:24:49Chamanlal seems happy to do this for illegal immigrants like Dardan, but that's not all.
0:25:00 > 0:25:04Chamanlal is confident that he's selling access not just to a GP,
0:25:04 > 0:25:07but to the whole NHS.
0:25:23 > 0:25:25Dardan Luma is registered with a doctor,
0:25:25 > 0:25:28and by selling a place on a GP's list,
0:25:28 > 0:25:30Chamanlal may be committing fraud.
0:25:32 > 0:25:35And the doctor's appointment has come through.
0:25:35 > 0:25:37So I'm handing over the Dardan Luma identity
0:25:37 > 0:25:41to an Eastern European, Alex, who's really from the region.
0:25:43 > 0:25:46- Hi.- Hi.
0:25:46 > 0:25:51'Alex will be better placed to answer any questions that might come up about Dardan Luma's background.'
0:25:52 > 0:25:53We'll see how far we can get,
0:25:53 > 0:25:56- and I'll meet you afterwards and see what happens.- Definitely.
0:25:56 > 0:25:59- All right, good luck with it. - Thank you.
0:26:05 > 0:26:12Back in Birmingham, our undercover operative is meeting Asif Butt, the NHS practice manager.
0:26:12 > 0:26:15He wants to talk money.
0:26:16 > 0:26:20Raj's fictitious niece is registered with a doctor,
0:26:20 > 0:26:23and Asif has offered to help a group of Indian tourists get registered
0:26:23 > 0:26:27so they can come here for medical treatment.
0:26:47 > 0:26:49Asif's services don't come cheap.
0:26:49 > 0:26:53Even registering Raj's fictitious niece, Preeti, will be expensive.
0:26:54 > 0:26:58Asif says there are four mystery men further along the chain,
0:26:58 > 0:27:00all of whom need to be paid off.
0:27:37 > 0:27:41Raj is now apparently paying off Mr Butt and four other people.
0:27:54 > 0:27:56The cost is rising fast.
0:28:03 > 0:28:08We only have £500 on us, so we promise to come back with the rest.
0:28:08 > 0:28:10Asif tells us we're getting a bargain.
0:28:47 > 0:28:51Finally, Asif makes an appointment for Preeti with a doctor for the following week.
0:28:52 > 0:28:57By selling access to the GP's list, he may be committing fraud.
0:28:57 > 0:29:00There is no suggestion that anyone else at the clinic
0:29:00 > 0:29:04was involved in this, or received any money from Asif Butt.
0:29:09 > 0:29:15By now, each of our undercover patients, through the fixer, the middleman and practice manager,
0:29:15 > 0:29:19has been registered with a GP, and has an NHS number to show for it.
0:29:21 > 0:29:24The next step will be to introduce them to hospitals.
0:29:27 > 0:29:31But the rules are different when it comes to secondary care,
0:29:31 > 0:29:33to hospital care.
0:29:33 > 0:29:37Then, only people who are ordinarily resident in the UK,
0:29:37 > 0:29:41who have been here for more than a year, are entitled to free care.
0:29:41 > 0:29:44Virtually everybody else should pay.
0:29:46 > 0:29:47But we've been hearing problems
0:29:47 > 0:29:51with how hospital checks work in practice.
0:29:51 > 0:29:54We've been told that being registered with a GP means
0:29:54 > 0:29:57many overseas visitors are accepted into the system,
0:29:57 > 0:29:59no questions asked.
0:29:59 > 0:30:03Pam Ward was responsible for ensuring overseas visitors
0:30:03 > 0:30:05pay their bills in hospital.
0:30:05 > 0:30:10So a GP's referral could be a gateway into the system?
0:30:10 > 0:30:11Very easily.
0:30:11 > 0:30:14GPs would send a referral,
0:30:14 > 0:30:17there's no mandatory obligation for a GP
0:30:17 > 0:30:19to identify an overseas patient
0:30:19 > 0:30:23or a possible overseas patient to the hospital,
0:30:23 > 0:30:25so it could easily not get picked up.
0:30:25 > 0:30:31They have an English address, a registered GP, an NHS number,
0:30:31 > 0:30:36so there is really no way that the hospital will pick up from that.
0:30:36 > 0:30:41It's a common criticism from those making checks on overseas visitors.
0:30:41 > 0:30:43Once the hospital receives
0:30:43 > 0:30:45a referral from a general practitioner,
0:30:45 > 0:30:46I think there's an assumption
0:30:46 > 0:30:49that that patient is eligible for treatment.
0:30:49 > 0:30:50Not an unreasonable assumption -
0:30:50 > 0:30:53you would think that's something that had been checked with the GP,
0:30:53 > 0:30:54so many staff won't check.
0:30:56 > 0:30:58We've decided to put that to the test.
0:30:58 > 0:31:01Remember, we have three undercover reporters
0:31:01 > 0:31:05all now registered in the NHS on fraudulent grounds.
0:31:07 > 0:31:10Could they obtain free hospital treatment
0:31:10 > 0:31:13without anyone really checking who they are
0:31:13 > 0:31:16or whether they're entitled to NHS care?
0:31:16 > 0:31:19According to our NHS insider Asif Butt,
0:31:19 > 0:31:21that's not going to be a problem.
0:31:35 > 0:31:40Asif coaches us on how Preeti should behave to slip through the system.
0:32:00 > 0:32:03Asif logs on to the surgery's computer system
0:32:03 > 0:32:05to find out more about Preeti's medical condition.
0:32:21 > 0:32:23£800 to get into the NHS.
0:32:23 > 0:32:26A bargain, according to Asif.
0:32:27 > 0:32:29It's the day of the scan.
0:32:29 > 0:32:31Time to see if it's really as easy
0:32:31 > 0:32:36for someone who isn't entitled to get treatment as Asif makes out.
0:32:36 > 0:32:39Just outside the hospital here at Heartlands in Birmingham,
0:32:39 > 0:32:41about to go in for my MRI scan.
0:32:44 > 0:32:48Preeti goes for the scan, which, if she was a real health tourist
0:32:48 > 0:32:52and paid privately, would have cost about £800.
0:32:54 > 0:32:56But did the hospital detect her?
0:32:58 > 0:33:01So how did that go? What happened in the hospital?
0:33:01 > 0:33:03Basically, went in with my appointment card.
0:33:03 > 0:33:07I was asked to confirm my name, which is obviously my fake name,
0:33:07 > 0:33:11my date of birth, which I gave the fake date of birth,
0:33:11 > 0:33:14and also the first line of the address, which was also fake.
0:33:14 > 0:33:18And apart from that I was taken in, had the MRI scan, came out.
0:33:18 > 0:33:22So all of the information you gave in the hospital was fake?
0:33:22 > 0:33:23Correct, yeah. Everything.
0:33:23 > 0:33:26So did anyone ever ask you
0:33:26 > 0:33:29if you were ordinarily resident in the country, or...?
0:33:29 > 0:33:30Nobody did.
0:33:31 > 0:33:34If our undercover reporter was a real health tourist,
0:33:34 > 0:33:37the MRI scan could be just the beginning
0:33:37 > 0:33:39of a lifetime of free health care.
0:33:39 > 0:33:43We asked Heartlands Hospital about their failure
0:33:43 > 0:33:45to check Preeti's residency.
0:33:45 > 0:33:46They said that on this occasion,
0:33:46 > 0:33:50as the patient was referred via a known local GP practice,
0:33:50 > 0:33:52they assumed that they would have had to give details
0:33:52 > 0:33:55of their home address and national insurance number
0:33:55 > 0:33:58when registering at the doctor's.
0:34:02 > 0:34:06And what about Francis, who paid rather less - £300 -
0:34:06 > 0:34:09to the Nigerian fixer Femi, to join a South London practice?
0:34:12 > 0:34:13I caught up with him
0:34:13 > 0:34:15close to St Thomas' Hospital in central London.
0:34:17 > 0:34:20So, how's it going? Where are we at, at the moment?
0:34:20 > 0:34:23So I've been in to see the GP. I described my condition to her,
0:34:23 > 0:34:27and she said it must be restless legs syndrome.
0:34:27 > 0:34:29Restless legs syndrome?
0:34:29 > 0:34:33Yeah, and she gave me a referral to come to St Thomas' for some tests.
0:34:33 > 0:34:36- Oh, so you're going for some blood tests?- Blood tests.
0:34:36 > 0:34:39- So you're in the system now?- Yeah. That's what it looks like.
0:34:39 > 0:34:40I'm in the system, yeah.
0:34:43 > 0:34:47This is the form our undercover health tourist got from the doctor.
0:34:47 > 0:34:51It's a routine referral for blood tests to a hospital,
0:34:51 > 0:34:54but really, it's his ticket from the primary care system,
0:34:54 > 0:34:55which is the GP system,
0:34:55 > 0:34:57into the secondary care system, which is hospitals.
0:34:57 > 0:35:02Francis is going into the hospital for his blood tests.
0:35:02 > 0:35:06St Thomas' did not check whether he was eligible for free treatment
0:35:06 > 0:35:09before doing the tests, and he wasn't asked for any payment.
0:35:09 > 0:35:13A procedure that would have cost about £100 privately.
0:35:13 > 0:35:16We asked Guy's and St Thomas' Hospital why they didn't check
0:35:16 > 0:35:18our undercover man's story.
0:35:18 > 0:35:21They said they believed that in the vast majority of cases,
0:35:21 > 0:35:25patient eligibility would be established before treatment.
0:35:25 > 0:35:28They added that they've implemented more rigorous checks in A&E,
0:35:28 > 0:35:32which they anticipate extending to other outpatient services.
0:35:37 > 0:35:39'That's two of our undercover operatives
0:35:39 > 0:35:41'who've had free treatment,
0:35:41 > 0:35:43'but could the third get a free X-ray?
0:35:43 > 0:35:47'I caught up with Alex, who had taken on my role as Dardan Luma,
0:35:47 > 0:35:49'the Kosovan builder, to find out.'
0:35:49 > 0:35:53The last time I saw you, you were on your way to the doctor.
0:35:53 > 0:35:55- You done that now?- Yes, I did. I went to visit my GP.
0:35:55 > 0:35:59I asked for a referral to go to hospital and have an X-ray.
0:35:59 > 0:36:01He gave me one.
0:36:01 > 0:36:05This particular hospital, actually, is said to be
0:36:05 > 0:36:07at the forefront of policing this kind of thing,
0:36:07 > 0:36:09so we would expect them...
0:36:09 > 0:36:12- To check and ask? OK. Let's try. Let's see.- OK. Let's do it.
0:36:14 > 0:36:17'West Middlesex University Hospital.
0:36:17 > 0:36:20'It's been held up in Parliament as an example of best practice
0:36:20 > 0:36:25'for identifying and charging overseas visitors.
0:36:25 > 0:36:27'So if Dardan Luma is going to be exposed anywhere,
0:36:27 > 0:36:29'it should be here.'
0:36:32 > 0:36:37'Within 20 minutes, the X-ray for his bad back is all done.'
0:36:37 > 0:36:40- That was really quick, wasn't it? - Very quick indeed.
0:36:40 > 0:36:44- So I was with you at reception - they didn't ask much there.- No.
0:36:44 > 0:36:48They only asked, when I gave them the referral paper, my name,
0:36:48 > 0:36:51date of birth, and address.
0:36:53 > 0:36:55Now this hospital is quite close to Heathrow,
0:36:55 > 0:36:58and it's said to be at the forefront of policing
0:36:58 > 0:37:02whether people are really entitled to care, but today,
0:37:02 > 0:37:05for Dardan Luma, it was plain sailing.
0:37:07 > 0:37:11When we approached West Middlesex, they told us that in this case,
0:37:11 > 0:37:14because the patient was referred by a GP,
0:37:14 > 0:37:18staff assumed he was entitled to free NHS treatment.
0:37:18 > 0:37:22The hospital said it was retraining staff always to double-check
0:37:22 > 0:37:26that GP-referred patients are entitled to free testing.
0:37:26 > 0:37:30Generally, it said it's confident that its systems are very robust.
0:37:30 > 0:37:34Now, one of the reasons staff may not be checking is because
0:37:34 > 0:37:36the rules on who should and shouldn't pay
0:37:36 > 0:37:39are just so complicated. Have a look at this.
0:37:39 > 0:37:42This is the Government guidance on the issue.
0:37:42 > 0:37:46It's nearly 100 pages long - not exactly light reading.
0:37:46 > 0:37:48And this concerns who should pay
0:37:48 > 0:37:51and the kind of questions they should be asked.
0:37:51 > 0:37:55The guidance all hinges on one key term.
0:37:55 > 0:37:59"Ordinarily resident" is a phrase which sounds good common sense,
0:37:59 > 0:38:02but when it comes down to actually implementing it,
0:38:02 > 0:38:05the policy is often unworkable. This is the poor old NHS
0:38:05 > 0:38:08being given the task of implementing something which is unworkable.
0:38:08 > 0:38:10How does it work on the ground?
0:38:10 > 0:38:12People do their best to try and recover the money
0:38:12 > 0:38:16after patients have often dispersed back around the world.
0:38:16 > 0:38:18That's an even harder task.
0:38:21 > 0:38:25Hospitals are meant to check if a patient is entitled to care,
0:38:25 > 0:38:27whether they're referred by a GP
0:38:27 > 0:38:30or arrive through Accident and Emergency.
0:38:30 > 0:38:33A&E itself is free,
0:38:33 > 0:38:36but overseas visitors should pay for any further treatment.
0:38:37 > 0:38:41The hospitals we tested with our undercover reporters
0:38:41 > 0:38:43let them through without a problem.
0:38:43 > 0:38:45But what's the national picture?
0:38:47 > 0:38:52To find out, we asked all 171 trusts in England and Wales
0:38:52 > 0:38:55about their checks to identify overseas visitors.
0:38:55 > 0:38:57133 of them responded,
0:38:57 > 0:39:00and those responses were checked by two experts.
0:39:00 > 0:39:03They found that 45 trusts, a third of them,
0:39:03 > 0:39:06were not following Government guidance.
0:39:06 > 0:39:09'I put those results to the Health Minister.'
0:39:09 > 0:39:12- And a third of them are not doing the checks?- Yes.
0:39:12 > 0:39:14Actually, I think, if I was being honest about it,
0:39:14 > 0:39:16I'm surprised it's not
0:39:16 > 0:39:17- more than that.- Really?- Yes!
0:39:17 > 0:39:21Because we know that there is... We KNOW there is a real problem
0:39:21 > 0:39:23and that is why we are having the review.
0:39:25 > 0:39:29The hospital trust which appears to be one of the weakest
0:39:29 > 0:39:31at detecting unentitled overseas visitors
0:39:31 > 0:39:34was the Worcestershire Acute NHS Trust.
0:39:34 > 0:39:38They said they'd identified just one health tourist
0:39:38 > 0:39:44in the last four years, charging them a grand total of £889,
0:39:44 > 0:39:46despite serving a multicultural community.
0:39:48 > 0:39:51It turns out that the Worcestershire Trust
0:39:51 > 0:39:55doesn't have anyone responsible for identifying overseas visitors.
0:39:55 > 0:40:00Chris Skidmore is a Conservative MP who campaigns on this issue.
0:40:00 > 0:40:02The fact that we don't have somebody
0:40:02 > 0:40:05specifically co-ordinating and recording
0:40:05 > 0:40:08does suggest that's one of the reasons why so few people
0:40:08 > 0:40:11have actually ended up being logged on their books
0:40:11 > 0:40:14as being not eligible for care.
0:40:14 > 0:40:16- Save the NHS!- Save the NHS!
0:40:16 > 0:40:19Worcestershire is a trust under pressure.
0:40:19 > 0:40:22It has to make savings of £50 million by 2015.
0:40:24 > 0:40:28A&E and maternity services at Redditch Alexandra Hospital are at risk.
0:40:28 > 0:40:30Locals are up in arms at the proposed cuts,
0:40:30 > 0:40:34so could Worcestershire be wasting valuable resources
0:40:34 > 0:40:36by not charging overseas visitors?
0:40:36 > 0:40:40Worcestershire said it was committed to managing its finances effectively
0:40:40 > 0:40:44and that losses have to be judged against the costs of recovery.
0:40:44 > 0:40:47It said whilst it doesn't have a specific role,
0:40:47 > 0:40:50it does have systems to monitor and recover money
0:40:50 > 0:40:52owed by overseas patients.
0:40:52 > 0:40:55It said it was currently in the process of recovering money
0:40:55 > 0:40:56from three such patients.
0:40:58 > 0:41:02It's government policy that hospitals should make these checks
0:41:02 > 0:41:04so what does the new minister say?
0:41:04 > 0:41:06You might be surprised.
0:41:06 > 0:41:09There are many people who are watching this programme,
0:41:09 > 0:41:11probably myself amongst them,
0:41:11 > 0:41:14who would be offended, frankly, if every time I went to hospital,
0:41:14 > 0:41:17I was effectively being asked to prove
0:41:17 > 0:41:19I was entitled to free NHS treatment.
0:41:19 > 0:41:21I don't think anybody wants that system.
0:41:21 > 0:41:23What we don't want are the abuses.
0:41:25 > 0:41:27Despite the obvious confusion in the system,
0:41:27 > 0:41:31some overseas visitors are identified and charged,
0:41:31 > 0:41:33but how many?
0:41:33 > 0:41:37Well, we asked all of the 190 hospital trusts in the UK.
0:41:37 > 0:41:41121 trusts told us that in the last four years,
0:41:41 > 0:41:46just under 40,000 overseas visitors had been detected.
0:41:46 > 0:41:49But is that anything like the full story?
0:41:49 > 0:41:52I think the scale of the problem is really difficult to find.
0:41:52 > 0:41:55We just don't know how many people there are on the system
0:41:55 > 0:41:58because the processes we have in place are not robust enough.
0:41:58 > 0:42:02So we don't know because the system just doesn't pick people up?
0:42:02 > 0:42:04We don't know because the system isn't picking people up.
0:42:06 > 0:42:10So how much is overseas visitors' failure to pay
0:42:10 > 0:42:12actually costing the NHS?
0:42:12 > 0:42:17Well, Panorama asked all 190 hospital trusts in the country
0:42:17 > 0:42:20how much money they've had to write off
0:42:20 > 0:42:21or how much is still outstanding
0:42:21 > 0:42:24from the treatment of foreign visitors since 2008.
0:42:24 > 0:42:28147 of them gave us a response
0:42:28 > 0:42:32and they told us that just under £40 million is outstanding
0:42:32 > 0:42:33or has had to be written off
0:42:33 > 0:42:36in the last four years.
0:42:37 > 0:42:40But that's just when hospitals actually do detect
0:42:40 > 0:42:42the overseas visitors.
0:42:42 > 0:42:44How many thousands don't get picked up and billed?
0:42:44 > 0:42:46I do think it's the tip of the iceberg.
0:42:46 > 0:42:4840 million, some people will say,
0:42:48 > 0:42:52"That's not much compared to the £110 billion budget of the NHS."
0:42:52 > 0:42:56But when you look at some of the trusts who've come back and said,
0:42:56 > 0:42:59"We have no bills whatsoever that are owed to us,"
0:42:59 > 0:43:00that's clearly not the case.
0:43:00 > 0:43:02They've clearly not been collecting the data.
0:43:04 > 0:43:07So the NHS seems to be haemorrhaging cash
0:43:07 > 0:43:12and we simply don't know how much. But beyond our shores,
0:43:12 > 0:43:14there's another way in which the NHS
0:43:14 > 0:43:16is paying out money it doesn't need to.
0:43:16 > 0:43:18And it's all to do with this...
0:43:18 > 0:43:21- ADVERTISEMENT: - This is the magic key.
0:43:21 > 0:43:24A European Health Insurance Card or EHIC.
0:43:24 > 0:43:25Like these holidaymakers,
0:43:25 > 0:43:29every year, millions of European citizens travel throughout Europe
0:43:29 > 0:43:33and during their holiday, thousands of people need urgent medical care.
0:43:36 > 0:43:38If you fall ill in Europe,
0:43:38 > 0:43:41you can use this card and the country you're in
0:43:41 > 0:43:44will bill the NHS for the cost of your treatment,
0:43:44 > 0:43:49so you might think there'd be close scrutiny of who gets an EHIC card.
0:43:49 > 0:43:50Think again.
0:43:53 > 0:43:54In fact, in Southall,
0:43:54 > 0:43:57our middleman Chamanlal is getting them for anyone
0:43:57 > 0:43:59who's willing to pay him for the privilege.
0:44:20 > 0:44:22We asked Chamanlal if he can get us a card
0:44:22 > 0:44:25in a randomly chosen fictitious name.
0:44:25 > 0:44:29To get the card, we'll have to supply a National Insurance number.
0:44:29 > 0:44:33It should be an important check in the system to stop fraud.
0:44:33 > 0:44:36But it's no problem, according to Chamanlal.
0:44:36 > 0:44:37He'll provide one.
0:44:50 > 0:44:53It costs us £340 for the EHIC card
0:44:53 > 0:44:56and for that, we also get a National Insurance card
0:44:56 > 0:44:58in the name of a fictitious tourist.
0:44:58 > 0:45:03It seems that if you've got the cash and contacts, it's easy.
0:45:03 > 0:45:06And just over a fortnight later, it arrived -
0:45:06 > 0:45:09a genuine EHIC card in a fake name.
0:45:10 > 0:45:14It's time to pick up the National Insurance card from the middleman.
0:45:29 > 0:45:32Then we pay him the remainder of his cash for the EHIC card
0:45:32 > 0:45:34and the fake National Insurance card.
0:45:53 > 0:45:55Now, with this EHIC,
0:45:55 > 0:45:58if the fictitious health tourist fell ill anywhere in Europe,
0:45:58 > 0:46:00he would get treatment
0:46:00 > 0:46:03and the NHS would pay the bill.
0:46:04 > 0:46:08In fact, it seems so easy, I decide to try it for myself.
0:46:08 > 0:46:11I'm going to use the online registration form
0:46:11 > 0:46:14to apply for an EHIC, but every detail I put on there will be fake
0:46:14 > 0:46:17or using details which don't match.
0:46:17 > 0:46:21I'll start with my invented illegal immigrant from Kosovo.
0:46:21 > 0:46:26Now, what I'm doing here is applying for an EHIC card for Dardan Luma
0:46:26 > 0:46:30but I'm not going to use the NHS number associated with him.
0:46:30 > 0:46:33In fact, I'm going to use a completely different one.
0:46:33 > 0:46:36Now, you'd think that's the kind of basic inconsistency
0:46:36 > 0:46:38that the system should pick up on.
0:46:39 > 0:46:43We've rebooted this exercise six times
0:46:43 > 0:46:46and each time, we got a real EHIC card.
0:46:46 > 0:46:50Here it is - the card for the illegal immigrant Dardan Luma.
0:46:50 > 0:46:53Each card is for a completely fictitious person.
0:46:53 > 0:46:56The system is wide open to fraud -
0:46:56 > 0:47:01fraud that's paid for by the NHS.
0:47:01 > 0:47:05We informed the Department of Health about this vulnerability.
0:47:05 > 0:47:10As it stands, there are very simple and obvious flaws
0:47:10 > 0:47:14in the system for getting a European Health Insurance Card, aren't there?
0:47:14 > 0:47:18- I mean, huge flaws.- You tell me that they're simple.- Well...
0:47:18 > 0:47:20I don't know if they are simple.
0:47:20 > 0:47:23I have no doubt that there is a problem with it
0:47:23 > 0:47:25and it's one that we are going to address.
0:47:29 > 0:47:33Bad as they are, the losses to the NHS from these card scams
0:47:33 > 0:47:37are being dwarfed by a much bigger problem
0:47:37 > 0:47:40in the way we deal with other European countries.
0:47:41 > 0:47:42Panorama has discovered
0:47:42 > 0:47:45that the NHS is losing significant amounts of money
0:47:45 > 0:47:50because of the health care agreements we have with Europe.
0:47:53 > 0:47:57Every year, nearly 11 million European visitors come here.
0:47:57 > 0:48:01We have reciprocal health care agreements with the rest of Europe
0:48:01 > 0:48:05so that each country claims back the cost of EHIC treatments
0:48:05 > 0:48:07from other member states.
0:48:09 > 0:48:14In 2010, the Government paid out £123 million
0:48:14 > 0:48:17for UK citizens who received medical treatment in Europe
0:48:17 > 0:48:20using their European Health Insurance Cards
0:48:20 > 0:48:24but we got just £38 million from other European countries.
0:48:24 > 0:48:26So why such a big difference
0:48:26 > 0:48:29between what we paid out and what we received?
0:48:32 > 0:48:35One major reason is that we don't add up
0:48:35 > 0:48:39how much British GPs spend treating Europeans across the country.
0:48:39 > 0:48:44Valerie Hughes was the NHS Counter Fraud Officer for Brighton and Hove.
0:48:44 > 0:48:46There were lots of tourists on her patch.
0:48:46 > 0:48:48The biggest problem is,
0:48:48 > 0:48:51we don't collect the information about those patients,
0:48:51 > 0:48:55the specific information relating to the individual,
0:48:55 > 0:48:59to be able to claim that money back from the community.
0:48:59 > 0:49:05We did a project in the Brighton city area and we...
0:49:05 > 0:49:09came up with the information that our GP practices
0:49:09 > 0:49:11that were working with us,
0:49:11 > 0:49:17that we were losing in the region of £200,000 in one financial year.
0:49:17 > 0:49:22So if we then times that throughout the whole of the country
0:49:22 > 0:49:26in primary care, just purely primary care we're talking here,
0:49:26 > 0:49:28we're talking millions.
0:49:28 > 0:49:32Some doctors are also concerned we don't charge Europeans for GP care.
0:49:32 > 0:49:33As an ordinary citizen,
0:49:33 > 0:49:37not so much as a GP, is that I'm not afforded this right
0:49:37 > 0:49:39in any other country I've ever been to.
0:49:39 > 0:49:42I meet many patients that come back from other countries
0:49:42 > 0:49:47and nearly always, there is some kind of payment arrangement.
0:49:47 > 0:49:50For example in the United States, it would be laughable
0:49:50 > 0:49:53to think of going to a family practitioner's clinic
0:49:53 > 0:49:55and expecting free treatment.
0:49:55 > 0:49:57We asked the minister
0:49:57 > 0:50:00why many European countries charge US for primary care
0:50:00 > 0:50:03but we don't charge them?
0:50:03 > 0:50:07We've found that many doctors do not collect the data
0:50:07 > 0:50:09so that we can charge the cost
0:50:09 > 0:50:12of treatment of European visitors back to Europe.
0:50:12 > 0:50:14Why aren't we doing that? That's a simple thing, isn't it?
0:50:14 > 0:50:17Well, it sounds simple but, of course as we know, it's very complex.
0:50:17 > 0:50:20We also know that the system is not working.
0:50:20 > 0:50:21That's why we're having a review.
0:50:25 > 0:50:29Every year, the NHS also pays European countries
0:50:29 > 0:50:33for treating our pensioners who are living abroad.
0:50:33 > 0:50:37In return, they pay us for treating their pensioners who live here.
0:50:40 > 0:50:46Last year, we paid out £734 million to other European countries
0:50:46 > 0:50:50but we got just £50 million back.
0:50:50 > 0:50:51Now, part of that money
0:50:51 > 0:50:54went towards payments on European Health Insurance cards
0:50:54 > 0:50:57but the vast bulk of it went to pay other countries
0:50:57 > 0:51:01for the health care costs of British pensioners who are living abroad.
0:51:01 > 0:51:06So why is it that we paid out so much and got so little back?
0:51:13 > 0:51:16Last year, one third of that money - £250 million -
0:51:16 > 0:51:22was sent to pay for the health care of people living here, in Ireland.
0:51:23 > 0:51:26These are people who have worked all of their lives in the UK,
0:51:26 > 0:51:30are now eligible for a British state pension
0:51:30 > 0:51:32and have come back here to retire.
0:51:32 > 0:51:36The UK Government picks up the tab for their health care.
0:51:39 > 0:51:42People like Maureen and her partner, Andy.
0:51:42 > 0:51:45What difference does it make to you that the UK Government
0:51:45 > 0:51:48- will pay for your health care here? - Oh, a great deal.
0:51:48 > 0:51:51We wouldn't be able to live here five minutes.
0:51:51 > 0:51:52We couldn't be here.
0:51:52 > 0:51:54And a lot of the return-to-Ireland people
0:51:54 > 0:51:58and people that have just moved over to Ireland for a quiet life,
0:51:58 > 0:52:00they wouldn't be able to stay.
0:52:01 > 0:52:03'Many in Ireland have to pay for their health care
0:52:03 > 0:52:05'but not Andy and Maureen.'
0:52:06 > 0:52:08Because we were in England for 52 years,
0:52:08 > 0:52:11you paid your contributions and you were entitled to that
0:52:11 > 0:52:13as if you were still in England.
0:52:13 > 0:52:16And the bill is taken up by...
0:52:16 > 0:52:18the British Government pays all this.
0:52:18 > 0:52:24- So for you, this is like having an NHS in Ireland?- Yes, it is.
0:52:24 > 0:52:26It is really the same thing.
0:52:26 > 0:52:30I mean, people used to talk about the National Health Service in the UK
0:52:30 > 0:52:34but, you believe me, it is the finest system in the world.
0:52:36 > 0:52:39Andy and Maureen are far from alone.
0:52:39 > 0:52:41In fact, the NHS pays for the health care
0:52:41 > 0:52:45of more than 40,000 British pensioners living here.
0:52:48 > 0:52:52But, for some reason, Ireland charges the NHS
0:52:52 > 0:52:55nearly £6,000 a year per pensioner,
0:52:55 > 0:52:59which is almost 50% more than the UK charges other countries
0:52:59 > 0:53:00to look after their pensioners.
0:53:00 > 0:53:04So why are we paying Ireland so much more?
0:53:04 > 0:53:08- So it just is more expensive? - It is more expensive.
0:53:08 > 0:53:12But taking that altogether, it doesn't seem to me that
0:53:12 > 0:53:16it would explain the full amount of that difference by some margin.
0:53:16 > 0:53:19Because we're talking about 50% more here, aren't we?
0:53:19 > 0:53:24I think if you were trying to do the calculations as carefully
0:53:24 > 0:53:28as possible, the chances are that the result would be perhaps 25,
0:53:28 > 0:53:32or even perhaps 30% more expensive than the equivalent care
0:53:32 > 0:53:36for this population would be in the UK.
0:53:36 > 0:53:39Do you believe it's likely then
0:53:39 > 0:53:42that the UK is paying over the odds?
0:53:42 > 0:53:44Maybe significantly over the odds for this?
0:53:44 > 0:53:47I think it probably is paying quite a lot more
0:53:47 > 0:53:49than the cost would justify, yes.
0:53:49 > 0:53:53Panorama has calculated that if Professor Norman's right,
0:53:53 > 0:53:58then the NHS has overpaid Ireland by £125 million
0:53:58 > 0:54:00in the last three years.
0:54:00 > 0:54:02The Irish Government dispute that figure.
0:54:02 > 0:54:04They say that average health care costs...
0:54:07 > 0:54:10..but, in any case, UK payments in recent years
0:54:10 > 0:54:12are based on estimates yet to be finalised.
0:54:12 > 0:54:13Therefore they said...
0:54:14 > 0:54:16..whether the UK has overpaid.
0:54:19 > 0:54:21In opposition, the Conservatives promised
0:54:21 > 0:54:25an inquiry into the UK's overpayments to Ireland.
0:54:25 > 0:54:27But that was three years ago.
0:54:27 > 0:54:31Are we paying the Republic of Ireland too much
0:54:31 > 0:54:33to look after UK pensioners living there?
0:54:33 > 0:54:36There's a HUGE problem with what's happening over in Ireland
0:54:36 > 0:54:39and that's why we're working with the Irish Government
0:54:39 > 0:54:41because we recognise that's an awful lot of money
0:54:41 > 0:54:43that we are paying back to the Irish Government,
0:54:43 > 0:54:45quite properly under the existing rules
0:54:45 > 0:54:47but they're very, very old rules.
0:54:47 > 0:54:50Both Governments accept that we need to sort it out
0:54:50 > 0:54:53so that it's not at the levels that it currently is.
0:54:55 > 0:54:59Back in Birmingham, the NHS practice manager, Asif,
0:54:59 > 0:55:00has been busy.
0:55:00 > 0:55:04He seems very keen to meet our undercover man again.
0:55:04 > 0:55:06It turns out he's already registered
0:55:06 > 0:55:08five fictitious Indian health tourists
0:55:08 > 0:55:11into the NHS even though we haven't paid him yet.
0:55:11 > 0:55:14The numbers are on this sheet of paper.
0:55:20 > 0:55:27It's an expensive piece of paper. Asif is expecting £5,000 for it.
0:55:27 > 0:55:30With a fond farewell, Asif reminds us
0:55:30 > 0:55:33he's eager to register another five health tourists on the NHS.
0:55:53 > 0:55:56But there won't be any more health tourists
0:55:56 > 0:55:59registered on the NHS through Asif Butt.
0:55:59 > 0:56:02And he isn't going to see his big payday.
0:56:02 > 0:56:05Instead, on the morning he comes to collect his money,
0:56:05 > 0:56:07he's going to meet me and my camera crew.
0:56:53 > 0:56:55Today he's a man of few words.
0:56:55 > 0:56:58He wasn't quite as reticent with our undercover reporter.
0:56:58 > 0:57:03And though he denies it, there's no doubt these people...
0:57:03 > 0:57:07are in the NHS because of him and they don't exist.
0:57:09 > 0:57:12We told Mr Butt's employers, Sparkbrook Health Centre,
0:57:12 > 0:57:16about his activities and they said, "We have launched...
0:57:19 > 0:57:22.."in conjunction with our local counter-fraud team
0:57:22 > 0:57:25"and will take appropriate action when all the facts are known."
0:57:27 > 0:57:30We asked the Southall middlemen, Ayub and Chamanlal,
0:57:30 > 0:57:33about their activities. They didn't respond.
0:57:33 > 0:57:35Femi has declined to comment
0:57:35 > 0:57:38other than saying the allegations are false.
0:57:38 > 0:57:44The NHS was never designed to charge people so, as we've found out,
0:57:44 > 0:57:46the systems it has in place for working out
0:57:46 > 0:57:48who's eligible for free treatment
0:57:48 > 0:57:51and who should pay are just not effective.
0:57:52 > 0:57:54Over the last six months,
0:57:54 > 0:57:57we've registered eight health tourists with GPs
0:57:57 > 0:58:00and we've had free treatment we should have paid for
0:58:00 > 0:58:03at hospitals across the country.
0:58:03 > 0:58:04No-one has been caught.
0:58:06 > 0:58:11We will be reimbursing the NHS for all of these costs.
0:58:11 > 0:58:15But in a world where people can travel ever more easily to Britain,
0:58:15 > 0:58:17we have to decide -
0:58:17 > 0:58:20who has the right to use the NHS for free?
0:58:20 > 0:58:22And who doesn't?
0:58:36 > 0:58:39Subtitles by Red Bee Media Ltd